Among the many predictions of Obamacare-related catastrophe was that the law, by enabling millions to join the ranks of the insured, would force us all to wait longer to see a doctor and very possibly lead to a code blue for U.S. health care.
“Doctor shortage, increased demand could crash health care system,” A CNN report warned last October.
A few months earlier, a Forbes headline predicted that, “Thanks to Obamacare, a 20,000 Doctor Shortage Is Set to Quintuple.”
“America is suffering from a doctor shortage,” wrote Forbes blogger Sally Pipes, president of the Koch brothers-funded Pacific Research Institute, a think tank advocating “personal responsibility” and “free-market policy solutions.” “An influx of millions of new patients into the healthcare system will only exacerbate that shortage — driving up the demand for care without doing anything about its supply.”
Pipes cited numbers from a 2010 analysis conducted by the Association of American Medical Colleges. But unlike Pipes’ organization, which says the Affordable Care Act should be repealed, the AAMC called the law’s expansion of coverage “long overdue.” The doctor shortage would be alleviated, the AAMC says, if rather then repealing Obamacare, Congress would lift a freeze in Medicare’s support for physician-training positions that has been in effect since 1997.
It’s true that the number of doctors per capita in the U.S. likely will continue to decrease, especially in rural areas. But even though an estimated 13 million Americans have become newly insured since the first of this year, the predictions of the gloom-and-doomers have not panned out.
To find out if the critics’ were prescient or way off base, Kaiser Health News reporter Phil Galewitz went looking for problems. He didn’t find many. “Five months into the biggest expansion of health coverage in 50 years,” he wrote after interviewing officials from more than two dozen health centers and multi-group practices across the country, “there are few reports of patients facing major delays getting care.”
One reason the system has not been overwhelmed is that, although we might not have as many doctors as some think we should have, we do have a rapidly growing supply of mid-level medical providers — like physician assistants and nurse practitioners — who now treat many of our health problems. It probably won’t be long before most of us are treated — and treated just fine — by a well-trained professional who doesn’t have an M.D. after his or her name.
A couple of weeks ago, I sustained an injury that my wife felt was serious enough that I should either go to the ER or see my doctor. When I called my doctor’s office, I was told that while the doctor was on vacation, a nurse practitioner could see me right away. And she did. And I lived to tell about it.
I had no misgivings. When I was at Cigna, many of my colleagues and I were treated by one of the nurse practitioners who staffed the company clinic. I went years without going to a doctor. The nurse practititoner not only was able to take care of any problems I had, she also was able to prescribe medications.
Thousands of nurse practitioners and physician assistants are joining the medical work force every year. According to the Bureau of Labor Statistics, physician assistants — who can do anything from physical exams to ordering lab tests — are among the fastest-growing professions in the country. An estimated 90,000 PAs are already seeing patients, and that number is expected to increase 38 percent by 2022.
One of the reasons for this growth is the roles they are now playing as part of patient-centered medical homes and accountable care organizations, both encouraged by the Affordable Care Act, to help coordinate patient care more efficiently. They are becoming an accepted and welcome part of the medical team, even by physicians.
Other mid-levels are also joining those medical teams in growing numbers. According to a recent study by the Brookings Institution, workers with less than a bachelor’s degree now account for nearly half of the total health care workforce in the country’s 100 largest metro areas. They include licensed practical nurses, personal care aides, and even registered nurses, although most RNs now have bachelor’s degrees. The Department of Labor predicts that an additional 3 million pre-baccalaureate health care professionals will join the medical workforce by 2022.
In the not too distant future, expect to see mid-levels in your dentist’s office too. Three states — Alaska, Minnesota and Maine — are the first to license dental health care therapists, who can and will help make up for a growing shortage of dentists.
So while we might not be seeing our doctors and dentists as often as we did in the past, we will be finding out that we didn’t really need to see them so often anyway.